Perioperative Myocardial Injury After Elective Neurosurgery: Incidence, Risk Factors and Effects on Mortality.

Abstract BackgroundPerioperative myocardial injury is an important reason of mortality and morbidity after neurosurgery. It usually is missed due to asymptomatic character. In the present study, we investigated myocardial injury after noncardiac surgery (MINS) incidence, the risk factor for MINS and association of MINS with 30-day mortality in neurosurgery patients.MethodsPatients with cardiac risk who underwent elective neurosurgery were enrolled to the study. The patients’ demographics, comorbidities, medications used, medical history, and type of operation were recorded. The high-sensitivity cardiac troponin (hs-cTn) levels of the patients were measured 12, 24, and 48 hours after surgery. The patients were considered as MINS-positive if at least one of their postoperative hs-cTn measurement values was ≥14 ng/l. All the patients were followed up for 30 days after surgery for evaluation of their outcomes, including total mortality, mortality due to cardiovascular cause, and major cardiac events.ResultsTotal 312 patients completed the study and 64 (20.5%) of them was MINS positive. Long antiplatelet or anticoagulant drug cessation time (OR: 4.9, 95%CI: 2.1-9.4) was found the most prominent risk factor for MINS occurrence. Total mortality rate was 2.4% and 6.2% in patients MINS negative and positive respectively (p = 0.112). The mortality rate due to cardiovascular reasons (0.8% for without MINS, 4.7for with MINS, and p=0.026) and incidence of the major cardiac event (4% for without MINS, 10.9 for with MINS, and p=0.026) were significantly higher in patients with MINS.ConclusionsMINS is a common problem after neurosurgery and, high postoperative hs-cTn level is associated with mortality and morbidity.

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Combination of SGLT-2 Inhibitors and GLP-1 Receptor Agonists: Potential Benefits in Surrogate and Hard Endpoints

Current Pharmaceutical Design ◽

10.2174/1381612824666180604113653 ◽

2018 ◽

Vol 24 (17) ◽

pp. 1879-1886 ◽

Cited By ~ 9

Author(s):

Michael Doumas ◽

Κonstantinos Imprialos ◽

Konstantinos Stavropoulos ◽

Andromachi Reklou ◽

Alexandros Sachinidis ◽

...

Keyword(s):

Microvascular Complications ◽

Total Mortality ◽

Cardiac Risk ◽

Cvd Risk ◽

Mortality And Morbidity ◽

Receptor Agonists ◽

Risk Patients ◽

Glucagon Like Peptide 1 ◽

Glycemic Targets ◽

Cvd Mortality

Background: The treatment of type 2 diabetes mellitus (T2DM) is complex; only a few patients successfully attain glycemic targets with monotherapy, most requiring drug combination therapy. Methods: The goal of this review was to identify in PubMed the complimentary ways of action leading to clinical benefit (in lowering HbA1c, body weight, renal, and cardiac risk factors and events) of the combination of sodium glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA). Results: SGLT2i, an emerging class of antidiabetic agents with an insulin-independent mechanism of action, are suitable for use in combination with any other class of antidiabetics, including insulin. The use of SGLT2i causes a reduction in Cardiovascular Disease (CVD) morbidity (mainly heart failure-HF) as well as total and CVD mortality. Besides insulin, SGLT2i may also be combined with incretin-based therapies, such as GLP-1 RA. The latter appears to reduce the rate or the progression of both macrovascular (mainly myocardial infarction-MI and stroke) and microvascular complications of DM, having a beneficial effect on all-cause mortality and CVD mortality, as well as CVD events. SGLT2i and GLP-1 RA may have a synergic effect on glucose reduction, weight reduction, renal impairment (both an independent lethal disease and a CVD risk factor) improvement, and cardiac event reduction, because the first reduces HF and related events and the second decreases CVD risk (mainly MI and stroke). Both also reduce total mortality, especially when combined with a statin. Conclusion: The combination of metformin with SGLT2i, GLP-1 RA, and a potent statin, in high CVD risk patients with DM, is expected to substantially reduce CVD mortality and morbidity, improving the quality of life of patients with DM at the same time. Prospective studies are needed to confirm this finding.

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P3514Gender differences in prognosis for total mortality among patients with ADHF: results of four-year follow-up

European Heart Journal ◽

10.1093/eurheartj/ehz745.0378 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

D Polyakov ◽

I Fomin

Keyword(s):

Mortality Rate ◽

Acute Decompensated Heart Failure ◽

Clinical Signs ◽

Regression Tree ◽

Total Mortality ◽

High Sensitivity ◽

Decompensated Heart Failure ◽

Mortality Rates ◽

Average Observation ◽

Clinical Conditions

Abstract Aim To obtain information on the effect of various predictors on the prognosis of a patient with acute decompensated heart failure (ADHF). Methods We investigated a sample of patients (n=719) hospitalized due to ADHF for 4 years (average observation duration was 2.3 years). 27 predictors were included in the model (clinical conditions and clinical signs of ADHF). We used regression tree method with CHAID algorithm with 10-fold cross-validation to determine the most important predictors of the prognosis. Results The most significant predictor for total mortality at the first branching was the gender of the patient. Mortality rate was 65.0% among males vs 47.9% among females (p<0.001). In the subgroup of males, the next most significant predictor for the prognosis was the level of systolic blood pressure (SBP): mortality rates was 79.6% with SBP ≤125 mm Hg vs. 57.2% with SBP >125 mm Hg (p=0.001). In the subgroup of males with SBP >125 mm Hg mortality rates differed depending on the presence of X-ray signs of congestion; when present, the total mortality was 65.7% vs. 47.8 in the absence (p=0.01). In the subgroup of females, the first most significant predictor of prognosis was diabetes mellitus (DM): mortality rates was 60.1% with DM vs. 41.2% without DM (p<0.001). The worst prognosis was found among those who are over 78 years old (55.8%) compared with younger (32.4%, p=0.001) for females with DM. The model has high sensitivity (74.9%) but low specificity (50.3%). In the ROC analysis, AUC was 0.673 (95% CI: 0.634–0.712). Regression tree for total mortality rate Conclusion The 4-year survival rate for patients with ADHF varies by gender. Among men, the most important predictors of prognosis were the level of SBP and the presence of congestion in the lungs at the hospital admission. Among women, DM and age had the greatest influence on the prognosis.

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Clinical study of cases of ruptured uterus in pregnancy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20175856 ◽

2017 ◽

Vol 7 (1) ◽

pp. 253

Author(s):

Anubha Vidyarthi ◽

Santwana Kumari

Keyword(s):

Risk Factor ◽

Caesarean Section ◽

Skilled Birth Attendant ◽

Fetal Outcome ◽

Previous Caesarean Section ◽

Mortality And Morbidity ◽

Risk Factor Management ◽

Incidence Risk ◽

One Year ◽

Ruptured Uterus

Background: Rupture uterus is a rare and often catastrophic condition. It is associated with a high incidence of fetal and maternal morbidity and mortality. It is a preventable condition. Timely diagnosis and management results in better outcome. The objective of this study was to determine incidence, risk factor, management, maternal and fetal outcome in cases of uterine rupture.Methods: A retrospective study of cases of ruptured uterus was done over a period of one year from January 2015 to December 2015. The case sheets of patients were traced through labor room register, operation theatre register and medical record section.Results: There were 57 cases of ruptured uterus out of total 8112 deliveries in labor room, giving incidence of 7.03/1000 deliveries (0.7%). The most common risk factor was previous caesarean section in 59.7% of cases. In 54.4% cases patients were multiparous (≥3). Most of the patients presented with poor general condition, abdominal pain and tenderness, palpable fetal parts and in shock in 68.4% cases. Patients were treated with immediate resuscitation and laparotomy followed by either repair or hysterectomy. There was high perinatal mortality of 89.5%. Maternal mortality was 3.5%.Conclusions: Proper antenatal care, appropriate counselling of patients with history of previous caesarean section for hospital delivery, training of skilled birth attendant can reduce mortality and morbidity associated with rupture uterus.

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Redefining the Prognostic Value of High-Sensitivity Troponin in COVID-19 Patients: The Importance of Concomitant Coronary Artery Disease

Journal of Clinical Medicine ◽

10.3390/jcm9103263 ◽

2020 ◽

Vol 9 (10) ◽

pp. 3263 ◽

Cited By ~ 2

Author(s):

Marco Schiavone ◽

Alessio Gasperetti ◽

Massimo Mancone ◽

Aaron V. Kaplan ◽

Cecilia Gobbi ◽

...

Keyword(s):

Mortality Rate ◽

Hospital Mortality ◽

Myocardial Injury ◽

High Sensitivity ◽

Cardiovascular Comorbidities ◽

History Of ◽

Coronary Syndromes ◽

Artery Disease ◽

Poor Outcomes ◽

Concomitant Coronary Artery Disease

Background: Although studies assessing cardiovascular comorbidities and myocardial injury in Coronavirus disease 2019 (COVID-19) patients have been published, no reports focused on clinical outcomes of myocardial injury in patients with and without chronic coronary syndromes (CCS) are currently available. Methods: In this study, consecutive COVID-19 patients admitted to four different institutions were screened for enrolment. Patients were divided into two groups (CCS vs. no-CCS). Association with in-hospital mortality and related predictors represented the main study outcome; myocardial injury and its predictors were deemed secondary outcomes. Results: A total of 674 COVID-19 patients were enrolled, 112 (16.6%) with an established history of CCS. Myocardial injury occurred in 43.8% patients with CCS vs. 14.4% patients without CCS, as confirmed by high-sensitivity cardiac troponin (hs-cTn) elevation on admission or during hospitalization. The mortality rate in the CCS cohort was nearly three-fold higher. After adjusting for disease severity, myocardial injury resulted significantly associated with in-hospital mortality in the no-CCS group but not in CCS patients. Conclusions: Patients with CCS and COVID-19 showed high mortality rate. Myocardial injury may be a bystander in CCS patients and COVID-19, while in patients without known history of CCS, myocardial injury has a significant role in predicting poor outcomes.

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Timing of Coronary Artery Bypass Grafting Surgery after Acute Myocardial Infarction

The Egyptian Cardiothoracic Surgeon ◽

10.35810/ects.v1i1.142 ◽

2020 ◽

Author(s):

Ahmed Fakhry ◽

Yahia Balbaa ◽

Waleed G Abo Senna ◽

Hesham Z Saleh

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Mortality Rate ◽

Artery Bypass ◽

Total Mortality ◽

Optimal Timing ◽

University Hospitals ◽

Mortality And Morbidity ◽

Group 4 ◽

Acute Mi

Background: Optimal timing for CABG surgery after myocardial infarction remains a matter of debate. The aim of our study was to analyze the effect of timing of CABG after acute myocardial infarction on operative mortality and morbidity. Methods: This prospective study included 60 patients who underwent isolated CABG within 30 days of acute myocardial infarction over 20 months (from the first of November 2014 till the end of June 2016) in Kasr Al-Ainy University Hospitals. Patients were divided into two groups; the early group (0 – 3 days) included 14 patients (23.3%) and the late group (4 – 30 days) included 46 patients (76.7%). The primary outcome was all-cause hospital mortality. Results: Our study included 43 males (71.7%) and 17 females (28.3%). The mean age was 58.4 ± 7.3 years. The total mortality rate was 8.3%. Patients undergoing early CABG experienced a higher mortality rate than those undergoing late CABG (21.4% vs 4.3%, P = 0.043). Also, early CABG was associated with more postoperative complications. Cardiogenic shock and early CABG were independent risk factors of mortality. Conclusion: CABG in the first 3 days after acute myocardial infarction was associated with high mortality and morbidity in comparison with late CABG. This suggests that CABG may best be deferred for more than 3 days after acute MI in non-urgent cases.

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Total Mortality in Cardiovascular Risk Factor Intervention Trials

Scandinavian Journal of Clinical and Laboratory Investigation ◽

10.3109/00365519009090535 ◽

1990 ◽

Vol 50 ◽

pp. 7-13 ◽

Cited By ~ 1

Author(s):

Ole Faergeman

Keyword(s):

Risk Factor ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factor ◽

Total Mortality ◽

Intervention Trials

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STUDY OF HS-CRP IN PEOPLE OF HUE CITY

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2015.1.5 ◽

2015 ◽

pp. 35-43

Author(s):

Anh Tien Hoang ◽

Kim Phuong Le

Keyword(s):

Risk Factor ◽

Risk Score ◽

Framingham Risk Score ◽

Strong Predictor ◽

High Sensitivity ◽

Cerebrovascular Risk Factor ◽

Framingham Risk ◽

Cerebrovascular Risk ◽

Hs Crp ◽

Positive Significant Correlation

Background: High sensitivity C reactive protein is a protein that occur in acute phase of inflammation. hs-CRP is considered as a predict factor of cardiovascular and cerebrovascular risk. Framingham risk score is a strong predictor of cardiovascular and cerebrovascular risk and death. In Viet Nam there was still few studies about hs-CRP and Framingham risk score. Objective: To study the concentration of hs-CRP in peoples in Hue city, also the correlation of hs-CRP and cardiovascular and cerebrovascular risk factor, Framingham risk score. Methods: Clinical data of 1471 people age from 30-74 living in Hue city. We do clinical exam, paraclinical exam. We find out the correlations between hs-CRP and the cardiovascular and cerebrovascular risk factor, the correlations between hs-CRP and Framingham risk score. Results: (i) The concentration of hs-CRP of people in Hue city was 1.54 ± 3.81 mg/l. The concentration of hs-CRP in hyper cholesterol, hyper LDL, hypertension, smoke, obesity and hypo HDL group was significant higher than in the others groups (p<0.05). There was positive significant correlation between the concentration of hs-CRP and systolic blood pressure r=0.061(p< 0.05); (ii) There was positive significant correlation betwee the concentration of hs-CRP and cardiovascular risk (r=0.083; p<0.01) cerebrovascular risk (r=0.068; p<0.05). Conclusions: hs-CRP was a predict risk factor in cardiovascular and cerebrovascular. Key words: hs-CRP, Framingham, cardiovascular, cerebrovascular

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Incidence, Risk Factors, and Outcomes of Preterm and Early Term Births: A Population-Based Register Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18115865 ◽

2021 ◽

Vol 18 (11) ◽

pp. 5865

Author(s):

Salma Younes ◽

Muthanna Samara ◽

Rana Al-Jurf ◽

Gheyath Nasrallah ◽

Sawsan Al-Obaidly ◽

...

Keyword(s):

Risk Factors ◽

Hospital Mortality ◽

Gestational Age ◽

Neonatal Intensive Care ◽

Population Based ◽

Incidence Rates ◽

Large For Gestational Age ◽

Mortality And Morbidity ◽

Early Term ◽

Incidence Risk

Preterm birth (PTB) and early term birth (ETB) are associated with high risks of perinatal mortality and morbidity. While extreme to very PTBs have been extensively studied, studies on infants born at later stages of pregnancy, particularly late PTBs and ETBs, are lacking. In this study, we aimed to assess the incidence, risk factors, and feto-maternal outcomes of PTB and ETB births in Qatar. We examined 15,865 singleton live births using 12-month retrospective registry data from the PEARL-Peristat Study. PTB and ETB incidence rates were 8.8% and 33.7%, respectively. PTB and ETB in-hospital mortality rates were 16.9% and 0.2%, respectively. Advanced maternal age, pre-gestational diabetes mellitus (PGDM), assisted pregnancies, and preterm history independently predicted both PTB and ETB, whereas chromosomal and congenital abnormalities were found to be independent predictors of PTB but not ETB. All groups of PTB and ETB were significantly associated with low birth weight (LBW), large for gestational age (LGA) births, caesarean delivery, and neonatal intensive care unit (NICU)/or death of neonate in labor room (LR)/operation theatre (OT). On the other hand, all or some groups of PTB were significantly associated with small for gestational age (SGA) births, Apgar <7 at 1 and 5 minutes and in-hospital mortality. The findings of this study may serve as a basis for taking better clinical decisions with accurate assessment of risk factors, complications, and predictions of PTB and ETB.

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